Isoflurane exposure in infant rats acutely increases aquaporin 4 and does not cause neurocognitive impairment

Isoflurane is commonly used in pediatric population, but its mechanism of action in cognition is unclear. Aquaporin 4 (AQP4) regulates water content in blood, brain, and cerebrospinal fluid. Various studies have provided evidence for the role of AQP4 in synaptic plasticity and neurocognition. In this study, we aimed to determine whether a prolonged exposure to isoflurane in infant rats is associated with cognition and what effect this exposure has on AQP4 expression. Ten-day-old [postnatal day (P) 10] Wistar albino rats were randomly allocated to isoflurane group (n = 32; 1.5% isoflurane in 50% oxygen for 6 hours) or control group (n = 32; only 50% oxygen for 6 hours). Acute (P11) and long-term (P33) effects of 6-hour anesthetic isoflurane exposure on AQP4 expression were analyzed in whole brains of P11 and P33 rats by RT-qPCR and Western blot. Spatial learning and memory were assessed on P28 to P33 days by Morris Water Maze (MWM) test. The analysis revealed that isoflurane increased acutely both mRNA (~4.5 fold) and protein (~90%) levels of AQP4 in P11 rats compared with control group. The increasing levels of AQP4 in P11 were not observed in P33 rats. Also, no statistically significant change between isoflurane and control groups was observed in the latency to find the platform during MWM training and probe trial. Our results indicate that a single exposure to isoflurane anesthesia does not influence cognition in infant rats. In this case, acutely increased AQP4 after isoflurane anesthesia may have a protective role in neurocognition

Management with Guidance of Minimally Invasive Cardiac Output Monitoring (PiCCO®) in Coronary Artery Bypass Surgery and Postoperative Results

Objective:Our study aimed to assess the correlation between the measured PiCCO® parameters and extubation time and intensive care unit (ICU) length of stay in patients who underwent coronary artery bypass grafting (CABG) surgery and were managed by monitorization of cardiac output and cardiac performance parameters with PiCCO®.Method:This study was conducted by retrospective analysis data of all 44 patients who underwent CABG surgery during December 2015-March 2016 and were managed through PiCCO® monitorization. The patients’ demographic characteristics (age, sex, weight, height, body mass index), American Society of Anesthesiologists physical conditions, comorbidities, ejection fractions, anesthetic management, operative details, hemodynamic data, PiCCO® parameters, extubation times, cardiovascular surgery ICU lengths of stay, requirements for vasoactive agent and blood transfusion, mortality, and morbidity were recorded from patient records and evaluated the correlation between the measured PiCCO® parameters and extubation time and ICU length of stay inpatients.Results:A significant increase was detected in the parameters of cardiac contractility and performance monitored with PiCCO® in the postoperative period (p<0.05). No significant correlation was found between PiCCO® parameters and extubation time and ICU length of stay (p<0.05).Conclusion:Coronary revascularization patients managed with the guidance of PiCCO® showed improved myocardial contractility and cardiac performance and no increase beyond what is anticipated in the extubation time and ICU lengths of stay of the patients. Thus, we believe that optimum volume and hemodynamic targets can be achieved in patients managed through monitorization of cardiac function parameters

Evaluation of Readmitted Patients After Intensive Care Unit Discharge (Retrospective Study)

Objective:Nearly %10 of the discharged patients are readmitted to intensive care unit (ICU) at the same hospital stay. Reduction of readmission rates could be used as a hospital performance indicator. Our aim is to analyse the reasons and results of readmissions of patients who were discharged to a general ward from ICU in a two-year period.Method:Readmissions of the patients who had been treated in our ICU between the dates of 01.01.2015-31.12.2016 were analysed retrospectively. Demographic characteristics of patients, readmission rates, initial admission indications and comorbidities, distribution of readmission indications, timing of readmission after discharge, distribution of patients in terms of mechanical ventilation need, discharge time of readmitted patients at initial admission to ICU after weaning, readmission mortality rates, Glasgow Coma Scale (GCS), APACHE-II and SOFA scores of patients at initial admission and readmission were analysed and compared.Results:59 patients (3.55%) are readmitted to ICU after discharge at the same hospital stay. When examining the departments where the readmitted patients came from, it is seen that 19 patients (32.2%) were readmitted to ICU from department of general surgery. 22 of readmissions (37.29%) occurred within first 48 hours after discharge. The most common reasons of readmissions are for postoperative monitoring after revisional surgery (44.07%) and acute respiratory failure (40.68%).Conclusion:The patients who are discharged from ICU are at a high risk of being readmitted to ICU (35). Readmission to ICU is associated with higher mortality risk than the initial admission. The first step of reducing the rates of readmission to ICU process is to anticipate the patients who would be readmitted to ICU priorly and improve service wards healthcare quality

Cerebral Salt Wasting Syndrome

A serum sodium (Na) value below 135 mEq/L is evaluated as hyponatremia. Hyponatremia is the most common electrolyte abnormality observed in hospitalized patients in particular. Hypovolemic hypoosmolar hyponatremia is the most frequent clinical table. One of the reasons of this is cerebral salt-wasting syndrome (CSWS). CSWS is a rare condition progressing with low plasma osmolality, urine osmolality above 100-150 mOsm/kg and urine- Na concentration above 20 mEq/L. In the blood and urine sample analysis performed upon sudden loss of consciousness on the 15th day of the intensive care unit follow-up of 79-year-old female patients due to falling from stairs, blood biochemistry Na value was 120 mEq/L, plasma osmolality was 250 mOsm/kg, urine Na value was 180 mEq/L, urine osmolality was 1200 mOsm/kg, urine diuresis was >3 mL/kg/hour. The central venous pressure was 2 mmHg. The patient, considered to be diagnosed with CSWS, was treated with 9% NaCl and 3% hypertonic saline solution. Her clinical course was improved on the 18th day. She died on the 81st day secondary to septicemia in the subsequent follow-up. In this article, it was aimed to report a patient with CSWS which progresses with low percentage in intensive care unit patients with head trauma, is frequently confused with inappropriate antidiuretic hormone syndrome and progresses mortally when not diagnosed distinctively well

Intranasal levosimendan prevents cognitive dysfunction and apoptotic response induced by repeated isoflurane exposure in newborn rats

Anesthetic-induced toxicity in early life may lead to risk of cognitive decline at later ages. Notably, multiple exposures to isoflurane (ISO) cause acute apoptotic cell death in the developing brain and long-term cognitive dysfunction. This study is the first to investigate whether levosimendan (LVS), known for its protective myocardial properties, can prevent anesthesia-induced apoptotic response in brain cells and learning and memory impairment. Postnatal day (P)7 Wistar albino pups were randomly assigned to groups consisting of an equal number of males and females in this laboratory investigation. We treated rats with LVS (0.8 mg/kg/day) intranasally 30 min before each ISO exposure (1.5%, 3 h) at P7+9+11. We selected DMSO as the drug vehicle. Also, the control group at P7+9+11 received 50% O-2 for 3 h instead of ISO. Neuroprotective activity of LVS against ISO-induced cognitive dysfunction was evaluated by Morris water maze. Expression of apoptotic-related proteins was detected in the whole brain using western blot. LVS pretreatment significantly prevented anesthesia-induced deficit in spatial learning (at P28-32) and memory (at P33, P60, and P90). No sex-dependent difference occurred on any day of the training and probe trial. Intranasal LVS was also found to significantly prevent the ISO-induced apoptosis by reducing Bax and cleaved caspase-3, and by increasing Bcl-2 and Bcl-xL. Our findings support pretreatment with intranasal LVS application as a simple strategy in daily clinical practice in pediatric anesthesia to protect infants and children from the risk of general anesthesia-induced cell death and cognitive declines.T.C. Health Ministry, Health Sciences University, Bagcilar Training and Research Hospital, Turke